Systemic lupus erythematosus – from trigger to prognostic

Silviu Valentin Stefanescu^(1,*), Luiza Pana⁽¹⁾, Razvan Ionescu^(1,2)

1) Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
2) Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Background. Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with complex and not fully understood pathogenesis, typically triggered by environmental factors in genetically susceptible individuals [1][2]. Among its many clinical manifestations, gastrointestinal involvement remains underdiagnosed and often overlooked [3]. Furthermore, immunosuppressive treatment increases the risk of serious infections, posing a significant challenge in distinguishing disease flares from infectious complications [4].
Case Report. We present the case of a 38-year-old woman with autoimmune thyroid disease who developed flu-like and digestive symptoms following a suspected insect bite, later confirmed to be due to Rickettsia conorii infection. Despite antibiotic treatment, she experienced persistent symptoms and a purpuric rash, eventually leading to a diagnosis of SLE based on clinical and immunological criteria. The patient experienced multiple disease flares with gastrointestinal and systemic involvement, including lupus enteritis, nephritis, and severe anemia. Her condition was further complicated by sepsis, MRSA endocarditis with mitral valve destruction, pulmonary edema, and multiple organ dysfunction syndrome. Despite initial critical illness and prolonged intensive care, the patient gradually recovered after multidisciplinary interventions, including immunosuppressive therapy, antimicrobial treatment, and renal support.
Conclusion. This case underscores the diagnostic and therapeutic complexity of SLE, particularly when gastrointestinal and infectious complications co-exist [3][4]. It highlights the importance of distinguishing between disease flare and infection in immunocompromised patients. Timely imaging, vigilant monitoring, and interdisciplinary collaboration are essential for appropriate management. The evolving understanding of microbiome alterations and immune dysregulation in SLE may offer future therapeutic insights [5]. Ultimately, this case illustrates the need for a personalized, holistic approach to autoimmune disease management.

Keywords: systemic lupus erythematosus; lupus enteritis; Rickettsia conorii; sepsis; infectious endocarditis; immunosuppression; MRSA; autoimmune disease; microbiome; multiorgan dysfunction

Corresponding author(s): Silviu Valentin Stefanescu, Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania, e-mail: valentinstefanescu97@gmail.com